Mitigating unintentional injury deaths in sport and recreation: insights from 14 years of coroner recommendations in Québec, Canada.

Background: Unintentional injury deaths in sport and recreation represent a significant public health concern. This study analysed coronial recommendations related to such deaths, focusing on case specifics and recurring themes from January 2006 to December 2019.

Methods: This mixed-methods study used data from the Bureau du coroner du Québec. Reports with recommendations were analysed by sex, age group, context, mechanism and activity. A four-phase thematic analysis was conducted to emphasise the developed themes and connect them with the existing literature.

Results: Of 1937 coronial reports reviewed, 13.3% (n=258) contained at least one recommendation, totalling 609 recommendations (31 per 100 activity-related deaths). Reports were more likely to contain at least one recommendation for women (20.3%, p=0.0004), paediatric populations (≤5 years: 30.3%, p<0.0001; 6-11 years: 29.3%, p=0.0003; 12-17 years: 27.6%, p<0.0001), and organised events (55.0%, p<0.0001), despite most deaths occurring among men, adults and during unstructured events. All-terrain vehicle and snowmobile activities showed significantly lower rates of reports with recommendations (8.1%, p=0.0008 and 8.6%, p=0.0044, respectively). Most frequently addressed themes were Development, inspection and modification of bicycle infrastructure for cycling and Lake and river safety measures for swimming. Conflict with other types of users was the top theme for land motorsports, while Personal flotation device use was the most common for navigation activities.

Conclusions: Patterns from reports with recommendations will be shared with the Bureau du Coroner du Québec to improve coronial practices. Integrating recurrent themes and recommendations with activity-specific risk factors will help identify critical patterns and inform preventive measures holistically.